Exhibit (2) 1312.4(a) Williams Uniform Complaint Form Complaints may be filed anonymously. However, if you wish to receive a response to your complaint, you must provide the contact information below. Response requested? _____Yes
_____No
Contact Information: Name: ___________________________Address:________________________________ Phone Number: Day: __________________ Evening:____________________________ Email: _______________________________ Location of the problem that is the subject of this complaint: School: ______________________________ Course title/grade level and teacher name: _____________________________________ Room number/name of room/location of facility: ________________________________ Date problem was observed: ________________________________________________ Only the following issues may be the subject of this complaint process. If you wish to complain about an issue not specified below, please use the appropriate district complaint procedure. Specific issue(s) of the complaint: (Please check all that apply. A complaint may contain more than one allegation.) 1.
Textbooks and instructional materials: (Education Code 35186; 5 CCR 4681) ______A student, including an English learner, does not have standardsalignment textbooks or instructional materials or state-or district-adopted textbooks or other required instruction material to use in class. ______A student does not have access to instructional materials to use at home or after school. This does not require two sets of textbooks or instructional materials for each student. ______Textbooks or instructional materials are in poor or unusable condition, have missing pages, or are unreadable due to damage. ______A student was provided photocopied sheets from only a portion of a textbook or instructional materials to address a shortage of textbooks or instructional materials.
2.
Teacher vacancy or misassignment: (Education Code 35186; 5 CCR 4681) ______A semester begins and a teacher vacancy exists. A teacher vacancy is a position to which a single designated certificated employee has not been assigned at the beginning of the school year for an entire year or, if the position is for a one-semester course, a position of which a single designated certificated employee has not been assigned at the beginning of a semester for an entire semester. ______A teacher lacking credentials or training to teach English learners is assigned to teach a class with more than 20% English learners in the class. ______A teacher is assigned to teach a class for which the teacher lacks subject matter competency.
Exhibit (2) 1312.4(b) 3.
Facility conditions: ______A condition exists that poses an emergency or urgent threat to the health or safety of students or staff as defined in AR 1312.4. ______A school restroom has not been cleaned or maintained regularly, is not fully operational, or has not been stocked at all times with toilet paper, soap, and paper towels or functional hand dryers. ______The school has not kept all restrooms open during school hours when students are not in classes and has not kept a sufficient number of restrooms open during school hours when students are in class. This does not apply when closing of the restroom is necessary for student safety or to make repairs. Please describe the issue of your complaint in detail. You may attach additional pages and include as much text as necessary to fully describe the situation. For complaints regarding facilities conditions, please describe the emergency or urgent facilities condition and how that condition poses a threat to the health or safety of students or staff. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
Please file this complain with the person specified below at the following location: For Analy High School Martin Webb, Principal 6950 Analy Ave Sebastopol, Ca 95472
For El Molino High School Frank Anderson, Co-Principal Doria Trombetta, Co-Principal 7050 Covey Road Foestville, CA 95436
For Laguna Continuation High School Ross Bickford, Principal 445 Taft Street Sebastopol, Ca 95472 Please provide a signature below. If you wish to remain anonymous, a signature is not required. However, all complaints, even anonymous ones, should be dated.
_____________________________________________ Signature
Approved: June 28, 2006 Revised: 12/12/07;
_______________________ Date
WEST SONOMA COUNTY UHSD Sebastopol, California
